Provider Demographics
NPI:1841442415
Name:NORTH COAST FOOT & ANKLE PC
Entity type:Organization
Organization Name:NORTH COAST FOOT & ANKLE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:D
Authorized Official - Last Name:CRILLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:814-823-3692
Mailing Address - Street 1:3530 PEACH ST
Mailing Address - Street 2:SUITE LL1
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16508-2768
Mailing Address - Country:US
Mailing Address - Phone:814-860-5036
Mailing Address - Fax:814-860-5063
Practice Address - Street 1:145 W 23RD ST
Practice Address - Street 2:SUITE 302A
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16502-2858
Practice Address - Country:US
Practice Address - Phone:814-454-5634
Practice Address - Fax:814-454-5639
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-15
Last Update Date:2009-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA138055Medicare PIN